2010/2011
Clerk to the Board, Minutes & Records Dept.
3299 Tamiami Trail East, Suite #401
Building F, 4th Floor
Naples, FL 34112
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Expires
BOARD OF COUNTY COMMISSIONERS
LOBBYIST REGISTRATION FORM
Name "71'07 ~ PAJ Date ~/~~J I (
Business Address I ,4M-P4- C \"r'1 C'B\J~R . Y\J fl~ 276 ()
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NAME AND ADDRESS OF EACH PERSON OR ENTITY REPRESENTED:
1). A~RFX (NC.
2).
(PLEASE ATTACH ADDITIONAL SHEETS, IF NECESSARY)
State of Florida
County of Collier
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~o yist Signature
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The for~g re istration was sworn to and subscribed before me on this
day of' ' ,b. , who is personally known to
me or has produced v as identification and
who did take an oath.
(B~\j}fS&\L(Grf~
Deputy Clerk/Notary Public
The annual registration fee is $25.00 per Lobbyist, according to Collier County
Ordinance No. 2003-53, as amended by Ordinance 2004-05 and Ordinance 2007-24.
Please make payment and mail to: Collier County Clerk of Courts or
Dwight E. Brock, Clerk of Courts (at the address listed at the top of the form).
Receipt# 007170602
6/28/2011 10:28:14 AM
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Dwight E. Brock
Clerk of the Circuit Court
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Customer
GUY WILLIAM
27810 SKYLINE CIR
WESLEY CHAPEL, FL
33544
Deputy Clerk
BMR CASHIER
M inutesand Records@CollierClerk.com
239-252-2646
Clerk Office Location
Collier County Gov!. Center
Building F, 4th Floor
3299 Tamiami Trail East,
Suite 401
P.O. Box 413044
Naples, Florida 34101-3044
1 Product
QUANTITY
1
DESCRIPTION
BMR Lobbyist Re9istration
UNIT COST
$25.00
TOTAL AMOUNT DUE:
Cash Tendered:
BALANCE DUE:
AMOUNT
$25.00
$25.00
($25.00)
$0.00
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